252 The Lymphocyte and Lymphocytic '/'issue 



process were the best examples of this phenomenon. Abnormal proteins also 

 modified the patient's prognosis and response to therapy to an extent which 

 invalidated an interpretation based purely upon microscopic analysis. These 

 rather rare complications often did not respond to therapy, even when all 

 other aspects of the patient's disease had been brought under control. 



Pre-existing or Coincidental Disease 



In this category, which modified histopathologic considerations, ^ve must 

 consider two possibilities, intercurrent disease that has no relationship to 

 the lymphoma and intercurrent disease that tends to occur or undergo 

 exacerbation as a result of the poor resistance of the patient. The former 

 group was obvious, typified by the lack of tolerance of severe anemia by a 

 patient who had severe cardiac insufficiency. 



The latter category was much commoner. Patients with lymphomas are 

 notoriously susceptible to infection, especially tuberculosis and mycotic 

 disease. Chemotherapy, steroids, and, to a lesser extent, x-ray therapy further 

 reduced the host's immunologic and cytologic defenses against infection. 

 Recognition of a complicating infection was often difficult since the symp- 

 toms may closely simulate those of activity of the lymphoma. Serial biopsy 

 has fortuitously unveiled the complicating infection. 



Prior Therapy 



Overzealous treatment was one of the most potent factors in inducing 

 a poorer prognosis; it served as a cause for a serous atrophy of the 

 marrow sufficient to make further therapy dangerous. Serous atrophy of fat 

 was especially prone to follow chemotherapy and radioisotope therapy be- 

 cause these agents exerted a systemic effect which depleted the marrow. 

 Local x-ray therapy was much less dangerous since only the marrow in the 

 path of the x-ray beam was significantly affected. Steroids were not toxic 

 to myeloid tissue and so were not hazardous in this regard. 



Case fi was an excellent example in which histopathologic analysis indi- 

 cated that a patient with chronic lymphatic leukemia had a relatively benign 

 disease and did not therefore require treatment. Unfortunately, her marrow 

 was so badly injured by over treatment that it led to her death from pancy- 

 topenia. 



CONCLUSIONS 



The term "favorable response to therapy" was limited to those situations 

 in which a patient, previously physically unable to meet the stress of a 

 normal way of life, was thereafter able as a result of treatment to cope 

 physically with these demands. 



